Doctor sparks debate over CPR

[TheAvatar]

Dersherwood, no I don't think he was saying he is the equivelent of todays doctor. It was an attempt to give himself credibility in the argument by suggesting that because he is more knowledgable than an Dr 100 years ago somehow means he is qualified to call one of todays doctors everything but a quack.

 

[jbd]

OK, here's the basic problem. As we breathe we not only take in oxygen, we off-gas waste products that if they were allowed to accumulate beyond tolerable levels would kill us in a matter of minutes. Now, hold your breath...60 seconds? 90 seconds? Now consider this...in cardio-pulmonary arrest the victim is not breathing. Brain death begins after 4-6 minutes without oxygen. Consider that the average response time from initial call to 911 to arrival at location of incident is 5 minutes. You now have about 1 minute to begin adequately ventilating the victim to not only provide oxygen, but remove carbon dioxide and other gasses and toxins from the blood. Continuous chest compressions only recirculates acidotic, de-oxygenated blood around the body and to the brain, causing systemic hypoxia most noticably indicated by that nasty smurf-blue color of the face, neck and head and mottling of the rest of the body. You must include ventilations during CPR or you are doing nothing but pushing on a dead guys chest. I have participated in hundreds of actual resuscitations, so I know the proven FACTS that are involved. FACT: resuscitation proceeds along a necessary path of Airway, Breathing, and THEN Circulation. FACT: Cardiac arrests in infants and children are overwhelmingly caused by RESPIRATORY problems to the tune of over 95%. FACT: The American Heart Assocation has visited and evaluated continuous chest compressions, and has repeatedly rejected it for it's lack of attention the oxygen requirements of the body in general, and the brain specifically. When we resuscitate patients in the field we are no longer giong for a pulse, we are going for a survivability and quality of life that allows the patient to walk out of the hospital and back into his or her life and to their family. Make no mistake, working a cardiac arrest even under the best circumstances is a messy, nasty, emotionally charged event. When I work one it is full tilt begining to end...all out with every resource I have and to not properly ventilate the person whose life I am trying so hard to save makes it a waste of my time and their life. As for standards...do you want the electrician you hire to wire your house to do it his way, or to code?

Do the ribs flex or bow when chest compressions are done? Of course they do, and it is this flexing of the ribs that is creating a bellows effect with the lungs. Air is is moved in and out of the lungs with each compression/release cycle. There is no need to use the full capacity of the lungs to accomplish oxygenation. People with severly diseased or impaired lungs survive quite well. An unconscious person doesn't need much oxygen to survive.

Keep in mind the CCC procedure is mostly aimed at the lay person with no other support equipment. They are simply trying to "buy" the patient a little time until the EMT's and or paramedics arrive with O2 delivery systems, intubation capabilities and medications let alone the extra manpower.

 

[Wildcard]

OK, time for my two cents here. Pair O medics is quite clearly a cook book medic. Read the cook book and follow it to the letter and never stop to look outside the box. I have been involved in EMS since 1979 and am in my 20th year as a paramedic including flight medic, ect. I was critical of this "new" advancement but chose to look further into it. After reading and talking with Mookie Mouse? a while back when this came up, Im sold. This will be the new standard in the very near future. The numbers are there, it works!.....For now, do what you were trained to do. Pump and blow.

45 minutes to run a code on scene? Cripes! Remind me to stay healthy there.

 

[Wildcard]

BTW, this will be the new ACLS standard too. Look into it and maybe just maybe you will be able to figure out what CCC is doing. It makes sense.

 

[ParamedicDiver1]

45 minutes to run a code on scene? Cripes! Remind me to stay healthy there.

I had to re-read the original post, I missed this statement, I agree that 45 minutes is a little long on scene times. Of course that depends on your scene support, we have fire support on all our CPRs and we try to average no more than 20 minutes on scene, course if you have a difficult intubation, or worse a hard extrication, say from the back bedroom of a singlewide trailer...ugh...might as well just cut a hole in the back of the trailer, it would be faster and easier. I have been known to run a code for up to an hour, but that was back when I did rural EMS and the closest ER was 45 miles away and we had no field termination protocols. These days I am within 10 minutes of a hospital anywhere in my district and the power of the Texas Medical Center just 20 mintes down the highway...thank God. I have also seen some of the numbers with the CCC-CPR and the numbers are pretty amazing, we in medicine have to remember that we are not a static science, we are an ever evolving changing science that must adapt to new trends when the data and scientific process requires us to change.

 

[redrover]

PairofMedics
As for the Good Samaritan laws...as long as you are doing your best to save the life of another you are immune from prosecution in both civil and criminal courts.

I remember it as: as long as you are doing your best within your education to save the life… Maybe I’m wrong or outdated but that is what I go by.
I’ve seen a lot of changes in protocols and as best as I could tell people welcomed improvements. But then I’ve always thought there was more than one way to do most things. I’m glad my training included time factors, how far away from advanced life support - onsite, 1 hour, 24 hours, 1 week, 1 month etc. and creative use of available resources.
BTW, haven’t seen the abhorrence to provide assistance so many people here experience – quite the opposite, must be the company I keep, lucky me.

 

[PairofMedics]

Thank youj...that's precisely what I meant. Just lke everything else there have been advances in medicine that brought it to where it is today.

 

[PairofMedics]

I had to re-read the original post, I missed this statement, I agree that 45 minutes is a little long on scene times. Of course that depends on your scene support, we have fire support on all our CPRs and we try to average no more than 20 minutes on scene, course if you have a difficult intubation, or worse a hard extrication, say from the back bedroom of a singlewide trailer...ugh...might as well just cut a hole in the back of the trailer, it would be faster and easier. I have been known to run a code for up to an hour, but that was back when I did rural EMS and the closest ER was 45 miles away and we had no field termination protocols. These days I am within 10 minutes of a hospital anywhere in my district and the power of the Texas Medical Center just 20 mintes down the highway...thank God. I have also seen some of the numbers with the CCC-CPR and the numbers are pretty amazing, we in medicine have to remember that we are not a static science, we are an ever evolving changing science that must adapt to new trends when the data and scientific process requires us to change.

Protocols being the unique animals they are obviously vary from service to service...mostly using logical explanations for their differences(geography, weather, population) Out of necessity and constrained by ERs that don't want dead folks taking up rooms live folks could occupy, we don't transport unless we have something to transport....i.e. a significantly positive change in condition. I agree, not the best of situations, but our ERs are seeing 500 patients a day...an average day. Currently, the minimum standard is 15:2, therefore I perform to that standard and agree with that standard based on the science behind it and my own field experience. Telling laypersons to only do compressions is one thing...telling professional rescuers to ignore airway is completely different. I welcome advances in medicine with open mind and arms, but it has to go the right way...not through one man. I believe that the full details of the study should be published so that we can objectively examine it ourselves. Believe it or not the AHA listens to us.

 

[jbd]

I welcome advances in medicine with open mind and arms, but it has to go the right way...not through one man. I believe that the full details of the study should be published so that we can objectively examine it ourselves. Believe it or not the AHA listens to us.

As I recall the recent TV news story about this, the city of Tuscon is testing or using the method and recording their results. The good Dr. is most likely the lead person but I doubt seriously that he propogated this all on his own. Its most probable that he has done some initial research and discussed this procedure both formally and informally with his colleagues. As noted by others earlier in this thread, the concept has been around for a a while. Time and experience will tell.

 

[ParamedicDiver1]

I welcome advances in medicine with open mind and arms, but it has to go the right way...not through one man. I believe that the full details of the study should be published so that we can objectively examine it ourselves.

I agree 110%...like all changes in medicine, CCC-CPR must stand up to the test before we announce sweeping changes. I know that my medical director has stated that he embraces CCC-CPR for the layperson, but has no plans to take away our advanced airway management techniques (Intubation-oral or nasal, LMA, combi-tubes, and emergency trachs). But he does like the idea of laypersons and potentially basic 1st responders doing CCC-CPR, *IF* the data holds up.